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Acute Internal Medicine

Nature of the
work

Acute Internal Medicine (AIM) is the specialty
within medicine that is concerned with the assessment, diagnosis
and management of adults presenting to secondary care with acute
medical illness. There is a broad spectrum of clinical work within
the specialty, including the immediate management of
life-threatening medical emergencies, the initial treatment (first
72 hours) of all acutely presenting medical ailments, and the
provision of ambulatory care. There is also a strong focus on
management and leadership, allowing doctors who train in
Acute Internal Medicine to run successful Acute Medicine Units
(AMUs)

Working in acute internal medicine

This is a hospital-based specialty, and the
majority of the work involves caring for medical patients around
the time of their admission to hospital. The spectrum of clinical
problems encountered in the AMU is very wide, which gives the work
a great deal of variability and enables trainees to become experts
in assessment, investigation, diagnosis and management across
multiple disciplines.

There is a focus on the recognition and
management of acute medical emergencies, but also on the
development of ambulatory care systems for patients with medical
problems who do not require immediate admission or indeed are
better treated on an out patient basis. Multidisciplinary team
working is key to an effective AMU; input from nursing staff,
physiotherapists, occupational therapists, pharmacists and social
workers is essential for a well-functioning unit.

Associated sub specialties

Acute Internal Medicine was formally
recognised as a specialty in 2009, having previously been a
subspecialty of General Medicine. The development of specialist
skills is a mandatory part of training in the specialty. Some
trainees will choose to learn a practical procedure such as
echocardiography, while others will gain qualifications in
management, leadership or education, and some will become involved
in medical research. The requirement to develop an additional
skill or qualification is a key element of the new curriculum.

Acute Internal Medicine is distinct from
Emergency Medicine (A&E), although specialist acute physicians
should work in close collaboration with specialists in Emergency
Medicine. There is also a close relationship with Critical Care,
and some trainees in this field will choose Acute Internal Medicine
as their ‘base’ speciality, before acquiring dual qualification by
CCT or certification with Critical Care Medicine.

Common Procedures / interventions

The breadth of the specialty is such that a
huge range of interventions will be practised. These include:

airway manoeuvres, including endotracheal
intubation

insertion of central venous
catheters

insertion of pleural and peritoneal
drains

DC cardioversion

Some trainees will also learn how to perform
specialist diagnostic or therapeutic procedures such as
echocardiography, bronchoscopy and upper G-I endoscopy.